SLEEP PROBLEMS & DISORDERS
Insomnia
Definition: difficulty falling or staying asleep for at least 3 nights per week for at least 1 month.
The most common sleep disorder.
Can be associated with symptoms of depression.
Contributing factors:
Age (higher prevalence as people get older)
Drug use (e.g., stimulants like caffeine can keep you awake)
Exercise (less activity → more energy, difficult to fall asleep)
Mental status (anxiety about sleep → cycle)
Bedtime routines
Treatment:
Stress management techniques.
Changes in problematic behaviors that could contribute to insomnia.
Cognitive-behavioral therapy (CBT) which focuses on cognitive processes and problem behaviors.
Parasomnias
Parasomnias involve unwanted motor behavior/experiences throughout the sleep cycle.
Sleepwalking:
Usually occurs during slow-wave sleep (i.e., stages 3 & 4).
REM sleep behavior disorder:
Occurs when the muscle paralysis associated with REM sleep does not occur.
Includes high levels of physical activity during REM sleep.
Often treated with Clonazepam (an anti-anxiety medication).
Restless leg syndrome:
Involves uncomfortable sensations in the legs when trying to fall asleep that are relieved by moving the legs.
Can be treated with a variety of medications.
Night terrors:
Sleeper experiences a sense of panic and may scream or attempt to escape.
Occur during NREM sleep.
Sleep Apnea
Occurs when individuals stop breathing during their sleep, usually for 10-20 seconds or longer.
Repeated disruptions in sleep lead to increased levels of fatigue.
Common in people that are overweight.
Types:
Obstructive – airway becomes blocked and air is prevented from entering the lungs.
Central – CNS fails to initiate breaths.
Treatment: continuous positive airway pressure (CPAP) device which pumps air into the person’s airways.
Sudden Infant Death Syndrome (SIDS)
The Safe to Sleep campaign educates the public about how to minimize risk factors associated with SIDS. This campaign is sponsored in part by the National Institute of Child Health and Human Development.
Occurs when an infant stops breathing during sleep and dies.
Infants younger than 12 months are at the highest risk.
Boys have a greater risk than girls.
Contributing factors:
Premature birth.
Smoking within the home.
Hyperthermia.
Some new preliminary research?
Narcolepsy
Involves an irresistible urge to fall asleep during waking hours.
Often triggered by states of heightened arousal or stress.
Shares many features of REM sleep including:
Cataplexy – loss of muscle tone while awake or in some cases complete paralysis of the voluntary muscles.
Hypnagogic hallucinations - vivid, dream-like hallucinations.
Treatment: psychomotor stimulant drugs (e.g., amphetamines) to increase neural activity.
Substance Use & Abuse
Sleep is one altered form of consciousness.
The use and abuse of substances is marked by another altered form of consciousness.
Substance Use Disorders
Substance use disorder is a compulsive pattern of drug use despite negative consequences (DSM-5 definition).
Involves physical/physiological & psychological dependence.
Physiological dependence – involves changes in normal bodily functions and withdrawal upon cessation of use.
Psychological dependence – emotional need for the drug.
Tolerance – occurs when a person requires more and more of a drug to achieve effects previously experienced at lower doses; linked to physiological dependence.
Withdrawal – negative symptoms experienced when drug use is discontinued.
(Credit: DSM-5)
Drug Categories (credit: modification of work by Derrick Snider)
Four main categories here:
Antipsychotics
Stimulants
Depressants
Hallucinogens
Additionally, antidepressants and opiates, and others not represented here.
They all have one thing in common: they act to produce psychological effects through interacting with our body’s endogenous neurotransmitter system.
Drug Categories: Drugs and Their Effects
Class of Drug: Stimulants
Examples: Cocaine, amphetamines (including some ADHD medications such as Adderall), methamphetamines, MDMA ("Ecstasy" or "Molly").
Effects on the body: Increased heart rate, blood pressure, body temperature.
Effects on behavior/psychology: Increased alertness, mild euphoria, decreased appetite in low doses; at high doses, increased agitation, paranoia, possible hallucinations; some can cause heightened sensitivity to physical stimuli; high doses of MDMA can cause brain toxicity and death.
Addictive? Yes
Class of Drug: Sedative-Hypnotics ("Depressants")
Examples: Alcohol, barbiturates (e.g., secobarbital, pentobarbital), Benzodiazepines (e.g., Xanax).
Effects on the body: Decreased heart rate, blood pressure.
Effects on behavior/psychology: Low doses increase relaxation, decrease inhibitions; high doses can induce sleep, cause motor disturbance, memory loss, decreased respiratory function, and death.
Addictive? Yes
Class of Drug: Opiates
Examples: Opium, Heroin, Fentanyl, Morphine, Oxycodone, Vicoden, methadone, and other prescription pain relievers.
Effects on the body: Decreased pain, pupil dilation, decreased gut motility, decreased respiratory function.
Effects on psychology: Pain relief, euphoria, sleepiness.
Addictive? Yes
Class of Drug: Hallucinogens
Examples: Marijuana, LSD, Peyote, mescaline, DMT, dissociative anesthetics including ketamine and PCP.
Effects on the body: Increased heart rate and blood pressure that may dissipate over time.
Psychological effects: Mild to intense perceptual changes with high variability based on strain, method of ingestion, and individual differences.
Addictive? Yes
depressants
Depressants – drugs that suppress the central nervous system activity.
Mnemonic: “d” in “Depressants”, “d” for “dial down”
Mechanism: These act as GABA agonists
Rationale: GABA has a quieting effect on the brain; depressants bind to GABA receptors which makes the neuron less likely to fire.
Common examples:
Alcohol
Barbiturates (anticonvulsant medication)
Benzodiazepines (anti-anxiety medication)
Alcohol specifics:
Decreases reaction time and visual acuity.
Lowers levels of alertness.
Reduces behavioral control.
Can result in complete loss of consciousness.
GABA
The GABA-gated chloride (Cl-) channel is embedded in the cell membrane of certain neurons.
The channel has multiple receptor sites where alcohol, barbiturates, and benzodiazepines bind to exert their effects.
This opens the chloride channel, allowing negatively-charged chloride ions (Cl-) into the neuron's cell body.
Changing its charge in a negative direction pushes the neuron away from firing; thus, activating a GABA neuron has a quieting effect on the brain.
Stimulants
Stimulants – Increase (stimulate) overall levels of neural activity.
These often work as dopamine agonists:
Prevent the reuptake of dopamine.
Dopamine activity is associated with reward and craving.
Therefore, these drugs can be highly addictive.
Common examples:
Cocaine
Amphetamine
Cathinones (i.e., bath salts)
MDMA
Additional note: Crack rocks are smoked to achieve a high. Smoking a drug allows it to enter the brain more rapidly, which can often enhance the user’s experience.
Side effects: Nausea, elevated blood pressure, increased heart rate, feelings of anxiety, hallucinations and paranoia.
Dopamine Agonists
As one of their mechanisms of action, cocaine & amphetamines block the reuptake of dopamine from the synapse into the presynaptic cell.
This results in a larger amount of dopamine in the synapse.
Nicotine and Caffeine
Caffeine:
Primarily acts as an antagonist for adenosine (adenosine impacts sleep).
May indirectly impact dopamine transmission.
As a result, increases levels of alertness and arousal.
However, much less potent.
Nicotine:
Interacts with acetylcholine receptors.
Highly addictive.
(Note: not just cigarettes; vaping also contains nicotine!)
Plays a role in arousal and reward mechanisms.
Opiods
Serve as analgesics (decrease pain) through their effects on the endogenous opioid neurotransmitter system.
Highly addictive.
Common Examples: Heroine, Morphine, Methadone, Codeine
Hallucinogens
Cause changes in sensory and perceptual experiences.
Can involve vivid hallucinations.
Variable with regards to the specific neurotransmitter systems they affect:
Mescaline and LSD (serotonin agonists).
PCP and ketamine (NMDA glutamate receptor antagonists).
Other States of Consciousness
This section encompasses states beyond ordinary wakefulness and the listed substances and disorders.
Hypnosis
Hypnosis is an extreme focus on the self that involves suggested changes of behavior and experience.
Clinicians may use relaxation and suggestion in an attempt to alter the thoughts and perceptions of a patient.
Has been used to draw out information believed to be buried in someone’s memory.
Unlike portrayals in the media, individuals undergoing hypnosis are in control of their own behaviors.
People vary in their ability to be hypnotized.
Uses include pain management, treatment of depression and anxiety, quitting smoking and weight loss.
Popular portrayals have led to widely-held misconceptions.
Clinical hypnotherapy
Meditation
This is a statue of a meditating Buddha, representing one of the many religious traditions of which meditation plays a part.
People practicing meditation may experience an alternate state of consciousness.
Meditation is the act of focusing on a single target such as breath or a repeated sound to increase awareness of the moment.
Meditation involves relaxed, yet focused, awareness.
Shows promise in stress management, sleep quality, pain management and treatment of mood and anxiety disorder.
Mindfulness & meditation exercises are freely available on YouTube, Spotify, and other online platforms!